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The Role of Neuroimaging in the Study of Aphasia Recovery and Rehabilitation

Research Needs and Opportunities: Summary and Recommendations

The NIDCD has had a longstanding commitment to research in treatment of adult aphasia. In 1991, the NIDCD sponsored a workshop on the topic, which resulted in a monograph, "Aphasia Treatment: Current Approaches and Research Opportunities" and an RFA "Treatment and Rehabilitation of Adult Aphasia". Despite these early efforts, as well as the identification of rehabilitation research as a priority in the NIDCD Strategic Plan, the number of NIDCD-supported research studies focused on the topic has remained limited. As a result, in 2001, NIDCD began to develop a workshop focused on rehabilitation of adult aphasia; soon thereafter, Senate Appropriations Committee language encouraged the various NIH institutes that had an interest in aphasia research to "expand and better coordinate their support of research into the cause, incidence, treatment and prevention of aphasia", and to delineate "those areas with the most potential for yielding significant advances in… treatments and rehabilitation methodology". Accordingly, the advice and direction of a number of researchers in the fields of neuroimaging, aphasia and rehabilitation were incorporated into the development of the workshop.

The NIDCD workshop, "The Role of Neuroimaging in the Study of Aphasia Recovery and Rehabilitation: Research Needs and Opportunities" was held on the NIH campus May 13, 2002. The purpose of the workshop was to 1) identify research opportunities for the application of neuroimaging methods to the study of aphasia recovery and rehabilitation; 2) to identify and address particular methodological challenges of imaging research focusing on the issue of aphasia recovery and rehabilitation; and 3) to develop strategies to encourage collaborative efforts among researchers with expertise in functional neuroimaging, language processing and aphasia rehabilitation.

Selected scientists whose research was relevant to the focus of the workshop were invited to attend. Presentations focused in three major areas: neuroplasticity and recovery of function; neuroanatomical and neurophysiological correlates of language processing in brain damaged individuals, using neuroimaging techniques; and recovery of language function and neuroimaging. Following presentations, lengthy discussion ensued and a number of recommendations and research needs were noted.

Following the workshop, the chairs and co-chairs assembled for summary discussions and identification of workshop themes and issues, regarding research needs and opportunities. The major discussion points are noted below. NIDCD encourages investigator-initiated research applications in all of the areas noted below. A focused solicitation is under development and will be released soon. For further information about funding opportunities, please contact Dr. Judith Cooper, Chief, Scientific Programs Branch, NIDCD at Judith_Cooper@NIH.GOV

Research Needs in Neuroimaging as It Relates to the Study of Aphasia and Aphasia Recovery

Document reliability of imaging results over time in aphasic individuals

Develop procedures for overcoming problems related to linguistic/cognitive task difficulty. Determine the effect of degrading tasks on activation patterns. Determine reliability of tasks within and across aphasic groups. Determine how to interpret imaging patterns when language performance is poor

Neuroimaging/Rehab Interface

Utilize imaging techniques to document the effect of particular treatment on brain functioning and/or to predict functional outcome/likelihood of retention of skills post-treatment

Determine utility of using neuroimaging data to determine the potential benefit of particular treatments

Examine the effects of timing of treatment on neural recruitment patterns, ie, early after a deficit, or after a delay (when acute changes have at least partially dissipated).

Treatment-Specific Issues

Study the effectiveness of components of intervention as well as combinations of intervention (for example, behavioral and pharmacotherapeutic);

Examine features of training: presence of feedback associated with each trial, context of stimulus use, the timing of stimulation, what the individual already has mastered in area to be trained

Identify the "cost" of treatment, ie, the possible detrimental effects of treatment, on other (nontreated) cognitive/language processes. Does competence in another domain suffer as treatment results in improvement in targeted area?

Develop approaches to documenting changes over time within the intervention setting

Determine the reliability and stability of measurement

Develop reliable, quantitative outcome measures

Determine efficacy of treatment as a function of intensity of treatment (focused, intense intervention vs. more traditional, less intense treatment) and the relation between intensity of treatment and recruitment of neural tissue in recovery

Identify responses which reflect restoration versus reorganization of function, that is, training to the deficit vs. teaching of compensatory strategies

Identify strategies that facilitate generalization of behaviors learned in treatment